Dentists see firsthand the damage that sugar causes on dental health and are an important alliance in the movement to end food-related disease.
The World Health Organization (WHO), the American Heart Association (AHA), and the United States Department of Agriculture (USDA) already agree that there should be limits to added sugar in the human diet.
Not surprisingly, the American Dental Association supports the new guidelines. They submitted an official response to the USDA Guidelines proposal, supporting the changes to added sugar recommendations and advocating for more sugar research.
The IRN is interested in strengthening the network of leaders in the dental community that are supporting limits on added sugar and reduction of processed foods in general. Our Advisor, Dr. Georgia Rogers, has compiled a list of resources that can be used when discussing sugar consumption with other healthcare providers. Her tips are:
Expect to face resistance.
Sugar has become ingrained in our culture as a “necessary” and expected component of many foods, especially for palatability after removing fat from processed food.
Resistance to reducing sugar may also be due to sugar’s addictiveness. Reducing sugar produces characteristics of craving and withdrawal due to altered and persistent chemical changes in the brain's reward center.
- How Sugar Affects the Brain
- Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake
- Neurobiologic basis of craving for carbohydrates
Further, the political influence of the sugar industry is pervasive, just like the tobacco industry. They have influenced professional organizations and the critical decision-makers within federal and state legislatures and agencies.
- The Secrets of Sugar
- Big Sugar’s Sweet Little Lies: How the industry kept scientists from asking: Does sugar kill?
- A Timeline of Sugar Spin: How the sweets industry won America's heart—and gut.
- Sugar Coated
Be prepared with facts.
Children age 9 to 18 have the highest sugar intake – about 17% of their daily calories are from added sugar. Almost half of the added sugar in the diets of Americans over age 2 comes from beverages such as soda and fruit drinks, sports or energy drinks, and coffee or tea. The next third comes from sweets, snacks and grains such as crackers, bread and cereal. Sugar is now found in foods that many consider healthy, like protein bars, yogurt and pasta sauce. Condiments like ketchup or salad dressing can also add a few extra teaspoons of sugar to your diet each day.
Nearly one-quarter (23%) of children aged 2-5, half (50%) of children 12-15, and two thirds (67%) of adolescents aged 16-19 suffer from tooth decay. Tooth decay is twice as common among poor or near-poor kindergarten aged children. Untreated dental disease adversely impacts children’s ability to pay attention in school, eat nutritious food, and interact with their peers.
Tooth decay is the most common reason that soldiers are dentally nondeployable, and the root cause of the majority of dental emergencies during deployment.
Dental caries is primarily a diet-dependent disease, and develops when normal oral flora that produce lactic acid by metabolizing simple carbohydrates grow out of balance. The more frequently cariogenic substances are consumed, the greater the likelihood that caries will develop. Eating or drinking meals, snacks or beverages more than 5 times a day significantly increases a child’s risk for tooth decay.
Free sugar intake has a log linear relationship with caries prevalence at the population level.
Sugar intake in excess of 5% of daily calories significantly increases caries experience. Reducing intake to 3% or less of daily calories can provide additional benefits in caries prevention.
- The contribution of dietary factors to dental caries and disparities in caries.
- Role of sugar and sugar substitutes in dental caries: a review.
- Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines.
Understand the systemic effects of excess sugar consumption.
We're all in this together. Dentists, pediatric primary care, general practitioners, internists, cardiologists, endocrinologists, school nurses, WIC, and Head Start should all add screening for excessive sugar consumption and counseling on sugar reduction to the preventive services that they provide, because of sugar’s systemic health effects.
Excessive sugar intake (especially fructose) has been shown to cause dyslipidemia and metabolic dysfunction in ways unrelated to calories or effects on weight.
Hepatic metabolism of dietary fructose results in de novo lipogenesis and increased uric acid levels.
Clinical trials have shown a dose-dependent increase in uric acid, triglycerides, and LDL cholesterol after just two weeks of high-fructose corn syrup intake (none vs. 10%, 17.5% or 25% of energy requirements).
Limiting sugar intake to less than 10% of total energy intake was shown to increase HDL over time.
Dietary restriction of added fructose has shown reductions in metabolic indicators such as diastolic blood pressure, lactate levels, triglyceride, and LDL-cholesterol. Glucose tolerance and hyperinsulinemia also improved.
- Adverse metabolic effects of dietary fructose: results from the recent epidemiological, clinical, and mechanistic studies.
- Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids.
- Usual intake of added sugars and lipid profiles among the U.S. adolescents: National Health and Nutrition Examination Survey, 2005-2010.
- A dose-response study of consuming high-fructose corn syrup-sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults.
- Added sugar intake and metabolic syndrome in US adolescents: cross-sectional analysis of the National Health and Nutrition Examination Survey 2005-2012.
- Consumption of less than 10% of total energy from added sugars is associated with increasing HDL in females during adolescence: a longitudinal analysis.
- Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome.
Sugar and Obesity
One daily serving increment of sugar-sweetened beverages was associated with an increase in BMI in children and weight gain in adults over the course of one year. Among adults with no dietary restriction, increased intake of dietary sugar was associated with an increase in weight, and reduced intake of dietary sugars was associated with a decrease in body weight.
- Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.
- Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies.
Sugar and Nonalcoholic Fatty Liver Disease (NAFLD)
Nearly all added sugars contain significant amounts of fructose, the sugar that makes fruit taste sweet. Unlike other sugar, fructose is processed in the liver, just like alcohol. Getting frequent, high doses of fructose throughout the day, without fiber to slow down its absorption, delivers more fructose to our liver than it was designed to handle. This can lead to fatty liver disease, scarring, and, in one fourth of patients, cirrhosis, which can cause death. Fatty liver disease also drives insulin resistance and metabolic syndrome.
Sugar and Diabetes
People who drink one to two sugar-sweetened beverages per day have a 29 percent higher risk of developing type 2 diabetes, compared to people who drink less than one per month. This is true for fruit juice as well as soda. A longitudinal study of added sugar intake looking at 175 countries showed that as sugar intake increased by 150 calories per day (about one sugary drink), the prevalence of diabetes increased 11-fold.
- Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.
- Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.
- Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct.
- The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data.
Sugar and Coronary Heart Disease (CHD)
Drinking just one 12-oz can of soda per day can increase your risk of dying from heart disease by nearly one-third. A longitudinal study that examined sugar consumption and risk for cardiovascular disease mortality found that those who consumed more than 25% of their daily calories from added sugar faced almost three times greater risk of death from cardiovascular disease than those who consumed less than 10%. Drinking just one 12-oz can of soda per day can increase your risk of dying from heart disease by 16%.
- Added sugar intake and cardiovascular diseases mortality among US adults.
- Sugar sweetened beverages consumption and risk of coronary heart disease: a meta-analysis of prospective studies.
Know the limit.
The American Heart Association recommends daily limits of about 150 calories (38 grams or 9 teaspoons) of added sugar for men and 100 calories (about 25 grams or 6 teaspoons) for women.
The World Health Organization recommends reducing the intake of free sugars to less than 10% of total energy intake to prevent obesity, and reduce total health care costs, and to less than 5% of total energy intake in order to prevent dental caries. This is based on the fact that the negative health effects of dental caries are cumulative, and even a small reduction of risk in childhood is of significance in later life.
The new USDA Dietary Guidelines for Americans recommends a limit for added sugars of no more than 10% of daily calorie intake. If a child eats 1500 calories a day, that’s no more than 150 calories from sugar, or about 9 teaspoons of sugar.
One Sweet App (Canada) - A sugar tracker that tells you how much sugar is in your food, so you can count how many teaspoons of sugar you actually eat. Free sugar is all types of added sugar, including juices, purees, concentrates, honey and all syrups. The stuff that’s now in 74% of our packaged foods, but that our nutrition label does NOT explain.
February is National Children's Dental Health Month.
We'd like to thank Dr. Georgia Rogers for offering these phenomenal tips for working together to reduce sugar intake. If you're making a difference in the dental community or beyond, please contact us and share your ideas with regard to these important issues. Any links to research and exemplary programs (linking diet and dental health) are also appreciated.